As the tube progresses down the gastrointestinal tract, the lining of the esophagus, stomach, and duodenum can be examined. There are a variety of procedures, tests, and evaluation of symptoms (for example, heartburn) to diagnose and evaluate patients with GERD. If refluxed liquid gets past the upper esophageal sphincter, it can enter the throat (pharynx) and even the voice box (larynx). The resulting inflammation can lead to a sore throat and hoarseness. As with coughing and asthma, it is not clear just how commonly GERD is responsible for otherwise unexplained inflammation of the throat and larynx.
Laparoscopic fundoplication is the procedure of choice for medically refractory GERD with excellent short-term results with respect to respiratory symptoms associated with GERD; however, long-term studies document a significant percentage of patients requiring ongoing acid suppression therapy. Reflux may not be the cause of all chest disease but it is â€œthe exciting causeâ€ of many.
Further GER diagnostic evaluation should be considered if symptoms worsen. Over time, some patients are able to taper off PPI therapy, although this is rare in our personal clinical experience.
Over-stimulating the vagus nerve might cause lung airway muscles to go into spasm as they do in an asthma attack. During reflux of stomach contents into the oesophagus and throat, stomach acid may get into the airways, causing irritation and inflammation, which in turn may cause tightening of the airways and provoke an asthma attack. Although researchers admit that the evidence is often conflicting and more studies need to be done into the connection between the 2 conditions, they have 2 main theories for how GORD could provoke asthma symptoms.
The foreign material is a potent irritant for the airways, creating wheezing, coughing, chest tightness, and other symptoms of asthma. Researchers have discovered that GERD can trigger asthma symptoms. In addition, GERD is more common in people with asthma than in the general population. Individuals whose asthma is especially hard to treat appear to be more prone to GERD than other affected persons. Asthma is a disease of increased responsiveness of the airways to various stimuli including allergens and irritants that cause obstruction of the airways.
Then the baby or child vomits. In other cases, the stomach contents only go part of the way up the esophagus.
In this way, refluxed liquid can cause coughing without ever reaching the throat! In a similar manner, reflux into the lower esophagus can stimulate esophageal nerves that connect to and can stimulate nerves going to the lungs. These nerves to the lungs then can cause the smaller breathing tubes to narrow, resulting in an attack of asthma. Long-standing and/or severe GERD causes changes in the cells that line the esophagus in some patients. These cells are pre-cancerous and may, though usually, become cancerous.
This can lead to asthma reactions or cause aspiration pneumonia. Such airway damage can affect breathing by causing coughing or wheezing.
Therefore, the many published reports on pH testing may be seriously underestimating the amount of GER actually occurring, and may not be useful to predict which patients have reflux-triggered or reflux-associated pulmonary disease. noted that esophageal acid markedly potentiated the bronchoconstrictive effects induced by voluntary isocapnic hyperventilation and methacholine provocation tests when compared to the airway responses with normal saline infusions. The total dose of methacholine required to reduce the forced expiratory volume in 1 second (FEV1) by 20% (PD 20 ) was significantly lower when esophageal acid was infused compared to normal saline. Furthermore, the vagus nerve is important for this mechanism because this response to esophageal acid was abolished with atropine pretreatment.
Cancer-associated direct or indirect vagal neuropathy diminishes control of the LOS. Alternatively reflux may be precipitated by the anxiety associated with the diagnosis.
Many asthma sufferers have comorbid conditions that contribute to the control (or lack of control) of their asthma. Gastroesophageal reflux disease, or GERD, is frequently involved with asthma but many patients donâ€™t make the connection that control of their asthma is tied to control of their GERD. There are a number of approaches to help these patients deal with GERD.
Until recently it has been impossible or difficult to accurately identify non-acid reflux and, therefore, to study whether or not non-acid reflux is injurious or can cause symptoms. One unresolved issue in GERD is the inconsistent relationships among acid reflux, heartburn, and damage to the lining of the esophagus (esophagitis and the complications).